A blood test for the strength of immunity is one of the effective indicators in diagnosing diseases associated with impaired immunity. A condition where the immune system is significantly weakened is called immunodeficiency. This condition can be primary, that is, congenital, or secondary. Primary immunodeficiency appears due to the presence of a genetic defect during development immune system. In most cases, it is determined fairly quickly. Children with weak immune systems from birth usually do not live longer than 6 years.

Secondary immunodeficiency is a consequence of negative changes in the immune system that is normal from birth. The reason for weakened immunity may be poor nutrition; if a person does not consume foods that are important for the normal functioning of the body, immunoglobulin will have nothing to form from. This cause is most often found in vegetarians and children.

Changes in the immune system can be detected by doing a blood test to determine the strength of the immune system. Liver diseases are the most common reason development of immunodeficiency in adults. It is in the liver that antibodies called “immunoglobulins” are formed. For example, if there is liver damage due to alcohol consumption or viral hepatitis This function is performed with violations.

When should you check your immune system?

Immunodeficiency always manifests itself in some way. If a person very often suffers from acute respiratory viral infections, which often occur with complications, or his herpes gets worse too often, boils form, or the mucous membranes are affected by thrush, it is worth checking the state of the immune system. Venereal diseases that are difficult to treat may also indicate a decrease in immunity. To understand the state of the immune system, you need to contact an immunologist and undergo an examination.

An immunogram is used to study immunity. This is an analysis that reflects the state in which the human immune system is.

Currently this system human body has not been studied enough, it is known that it performs such important task, as the elimination of agents that have entered the body ( chemical substances, bacteria, viruses).

There are two types of immunity that are considered basic:

• humoral, reacting to the penetration of foreign organisms, the destruction of which is carried out by special proteins - immunoglobulins;
• cellular, providing protection to the body with leukocytes.

Before checking the strength of immunity, it is necessary to study the possibilities provided by the immunogram. The indicators obtained as a result of such an analysis make it possible to diagnose both immunities.

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What is an immunogram?

The analysis, which is used to check the strength of immunity, makes it possible to estimate the number of leukocytes, both total and by subtype (lymphocytes, granulocytes, monocytes). Individual subpopulations of lymphocytes, such as CD cells, are also taken into account.

Immunogram is a method for determining the phagocytic activity of leukocytes.

This activity refers to the ability of protective cells (lymphocytes) to destroy bacteria. The taken biomaterial is examined to obtain information about the number of immunoglobulins and circulating immune complexes.

Blood is taken to test the strength of immunity in certain cases. An immunogram is performed when the following conditions are detected:

• infections that occur with relapses;
• oncology;
• autoimmune diseases;
• allergic diseases;
• diseases that are characterized as protracted and have a chronic form;
• suspected presence of AIDS.

The need for it exists during the study of patients who have undergone organ transplantation and who are undergoing this operation. This procedure it is also required to monitor a person’s condition while taking cytostatics, immunomodulators, and immunosuppressants. Definition process immune status consists of two stages. First they are made general analysis blood tests, general clinical tests, which are prescribed to everyone when visiting a doctor, regardless of their problem.

If a sexually transmitted infection is detected, the immunogram does not apply to mandatory procedures, because these patients usually do not have disturbances in the functioning of the immune system. An absolutely healthy person can become infected with a sexually transmitted infection. But some doctors believe that checking the body’s defenses is the basis for drawing up the correct treatment regimen.

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Who should undergo the study, how is it carried out?

Immunity testing is prescribed for people susceptible to colds, in cases where there is a high frequency of their occurrence and a long course. After detecting the level where the violation occurred, competent correction of the condition in which the patient is located is prescribed, aimed at improving health and improving the quality of life.

The material for the study is blood taken from a vein. Her intake includes quitting smoking, avoiding heavy exercise and training the day before the procedure. Before taking the test, you do not eat; it is taken in the morning, provided that more than eight hours have passed since the last meal. It is even forbidden to drink not only tea or coffee, but also ordinary water.

A child’s immunity is checked only if there are appropriate indications for this. We should not forget that the immune system is not formed immediately; its completion occurs at five years.

Patients with chronic diseases undergo more thorough research, requiring more time. During the test, certain immunity parameters are displayed. Such a study is necessary for frequently recurring pneumonia, sinusitis and bronchitis. Pustular skin diseases and infections caused by fungi are also indications for the procedure.

An immunogram can display indicators that indicate certain abnormalities. In young children, such changes are not considered a pathology. Frequent infections caused by viruses are more the norm for a child than a pathology. After all, the body must first recognize viruses and learn to fight them. And you should not interfere with the functioning of the immune system in such situations, since it can cause harm to health.

The results of the analysis are assessed by a specialist. An immunologist has knowledge that allows him to correctly interpret the data obtained from the material taken for research. He evaluates digital values ​​taking into account general condition the patient's health and the present clinical picture.

This disease has long been considered a type of paralysis, but it turned out to be the result of infection of the central nervous system with a virus that is safe for adults, but sometimes fatal for children. When paralytic (the most dangerous) polio develops, the immune system cannot oppose anything “serious” to it.

Poliovirus multiplies in the neurons of the spinal cord, one of the 2 main parts of the central nervous system. nervous systems s. And they are protected from the penetration of most protective blood bodies. But it is possible to prevent infection at any age, since the virus enters spinal cord through the intestines.

How are polio and immunity related?

Science currently knows 3 types of pathogens. I shows the greatest activity, especially in warm time of the year. Poliovirus enters the soil, water, air with the feces and saliva of patients, and can be carried by flies.

It is interesting due to its rapid death when heated and chlorinated, combined with Spartan resistance to digestion by the stomach and intestines, freezing, and processing. And also because its target tissues are not the neurons of the central nervous system, but the mucous membranes and lymph nodes closest to the place of entry into the body - pharyngeal or intestinal.

In the vast majority of cases, the infection does not go further than this, since immunity to it is formed earlier. The patient develops a fever, a sore throat, and sometimes a runny nose. If the intestines are also infected, flu-like symptoms are combined with diarrhea.

The patient usually does not even realize that he has had polio, mistaking it for or. Distinguish light form against acute respiratory infections, mononucleosis and other infections, blood, stool, and nasopharyngeal swabs are tested. Paralytic poliomyelitis is confirmed by cerebrospinal fluid samples.

Damage to neurons of the spinal cord and brain by the pathogen is a rare phenomenon (in relation to the total number of poliovirus infections, it does not exceed 1%). As a result of its activity, neurons die and paralysis occurs.

Death is most often observed when the respiratory center of the brain or the pathways that control the pulmonary diaphragm and heart rhythm are infected. But immunity after polio, which occurred in a paralytic form, is developed as stable as in a non-paralytic form.

The defense system cannot stop the progress of the paralytic form (nerve tissues and large parts of the central nervous system have immune privilege). It is weak antiviral protection that causes damage to the central nervous system in children (it does not yet work in full force) and adults (immunodeficiency is evident). Children are more susceptible to infection, but only after reaching 3 months of age, since from birth they are protected by antibodies received from the mother.

Supporting the body during treatment

There is no specific therapy for polio. The site of primary reproduction of the pathogen is opened and injected with additional portions of immunoglobulins - antiviral and antibacterial protective blood proteins responsible for long-term immunity. The rest of the treatment is palliative:

• activity limitation;
• analgesics;
• sedatives;
• hot compresses on paralyzed muscles.

If respiratory function is impaired, patients are transferred to the department intensive care. Attempts to restore the tone and mobility of paralyzed muscles with the help of physiotherapy begin from 4-6 weeks, when it becomes clear which of them are damaged and to what extent.

Immunity against paralytic polio is not as important as the fight for every surviving neuron. The protection tools inside the central nervous system still do not work, and it disappears on its own, simply because the nervous tissue is not the optimal habitat for the poliovirus. As maintenance therapy, the patient can be prescribed:

• group B - to relieve nervous symptoms and increase the chances of restoring the functions of the affected muscles after an illness. From 4 to 7 of this group are present in almost all edible plants. But there are only 20 of them, so it’s better to take drugs - “B-50” from the company “Now Foods” (11 B vitamins for 1415-1500 rubles with 100 tablets per package), “Blagomax” (7 components at a price of 193 rub. for 90 tablets), “Neurovitan” (5 representatives of the group at a cost of 830 rubles for 30 tablets);
• vitamin C - to “stimulate” an acute immune reaction in order to quickly produce one’s own immunoglobulins with specific antigens to the virus. It can be eaten with citrus fruits (no more than 300 g of fruit per day) or as part of “” from the pharmacy (up to 20 rubles for 10 tablets);
• introduction of third-party immunoglobulins - in case of their sluggish production in the patient’s body. For polio, only intramuscular or intravenous injections. Children from 3 months. dose 3-6 ml of the drug once, as soon as possible after suspicious contact or appearance warning signs. Adults are administered from 4.5 to 6 ml under the same conditions. You can buy 10 ampoules of normal human immunoglobulin for about 900 rubles. and more expensive.

Now popular with interferons, they are sometimes prescribed after 3-4 months. after suffering from polio. But they do not affect the course of the disease and are not prescribed in the acute stage.

How to boost immunity after suffering from polio?

A course of interferons helps increase resistance to viruses, since these proteins are synthesized by all cells, including nerve cells. The easiest way is to administer them rectally, and not intravenously - like “Viferon” (280-535 rubles for 10 pieces, depending on the concentration of the active substance).

It is also possible to locally inject/instill them into the nose and throat - as provided by Grippferon (from 370 rubles for a spray, about 130 rubles for the same volume of 10 ml). The course of interferons should not be extended for more than 2 weeks, but it can be repeated once every 4-6 months.

How is immunity to the disease formed?

There are 2 ways to acquire it - get sick or get vaccinated. In both cases, there is no intensity of immunity to polio, since the pathogen dies without leaving foci. But there is a difference in the consequences and effectiveness of using vaccines of one type or another.

1. OPV is a vaccine based on live, weakened poliovirus, produced according to the method of A. Sabin. It requires three administrations and, as a result, provides almost 100% protection against all strains of the pathogen for the rest of life (a single vaccination with it provides no more than 50% guarantees). Those vaccinated with it become completely immune to the virus. The main “catch” with it is the very vigorous reproduction of the introduced virus in the intestinal mucosa (in the same place and according to the same pattern where its usual “brothers” settle), which makes the vaccinated child/adult contagious, as in the acute stage of the disease. It is believed that a weakened strain of OPV cannot infect the central nervous system of people - the vaccinated person or those infected with it. But during its use, such cases were also observed (single cases, usually with 2-3 administrations and in patients with HIV).
2. IPV is a vaccine with formalin-killed pathogens invented by J. Salk. It is also administered 2-3 times (each injection produces a lifelong dose of one of 3 strains), resulting in 99% efficiency. Complications from it in the form of even exceptional cases of poliomyelitis in a vaccinated patient and infections of others were not observed. However, it completely and forever guarantees only against the paralytic form. A mild form You can get sick again within 5 years after vaccination.

If the patient has already been diagnosed with polio, immunity develops faster after vaccination, regardless of the form of the disease. For such a patient, a single application is often enough.

On conducting seromonitoring to study the state of population immunity to polio

Accepted Ministry of Health of the Orenburg Region,
Office of Rospotrebnadzor for the Orenburg region

1. Serological studies to study the condition specific immunity in indicator groups of the population are a mandatory element of epidemiological surveillance of polio and are carried out with the aim of monitoring the organization and implementation of vaccine prevention of this disease.
2. Due to the continued circulation of polioviruses in a number of countries in Africa and Asia and the ongoing real threat delivery wild strain of this pathogen into the region, it is extremely important to obtain objective data on the state of the population's immunity to polio.
3. In pursuance of the sanitary and epidemiological rules SP 3.1.1.2343-08 "Prevention of polio in the post-certification period" and the Action Plan for 2006 - 2008. to maintain the polio-free status of the Orenburg region

4. We order:

5. 1. To the chief doctors of the Buzuluk Central City Hospital and the Buguruslan Central City Hospital, the Gayskaya Central District Hospital, and the Novoorskaya Central District Hospital:
6. 1.1.
7. Organize blood sampling for serological testing for polio in indicator groups of the population in accordance with Appendix No. 1: in the cities. Buzuluk and Buguruslan in May 2008, in Gaisky and Novoorsky districts - in September 2008.
8. 1.2.
9. 1.4.
10. Ensure that the results of serological tests for polio are included in the appropriate medical records.
11. 2. The heads of the Eastern, North-Eastern, Western, North-Western territorial departments must ensure control over the correct formation of population groups subject to serological examination for polio, the organization and conduct of blood sampling and compliance with the deadlines for delivery of the material to the virological laboratory of the Federal State Institution "Center for Hygiene and Epidemiology in the Orenburg Region" region". 3. Chief physician of the Federal State Health Institution "Center for Hygiene and Epidemiology in the Orenburg Region" Vereshchagin N.N. ensure the examination of blood sera within 7 - 10 days from the moment of their receipt with the submission of research results to the Office of Rospotrebnadzor for the Orenburg region and the State Institution "Orenburg" regional center
12. on the prevention and control of AIDS and infectious diseases."
13. 4. Control over the execution of this order shall be assigned to the First Deputy Minister V.N. Averyanov. and Deputy Head of the Rospotrebnadzor Office for the Region Yakovlev A.G.
14. Minister of Health
15. Orenburg region
16. N.N. KOMAROV
17. Supervisor
18. Management
19. Rospotrebnadzor
20. in the Orenburg region

N.E.VYALTSINA

1. The procedure for selecting children for serological examination to determine the state of immunity to polio viruses
2. Serological monitoring of the state of collective immunity to polio should be carried out in the following indicator groups of the population:
3. - Group I - children aged 3-4 years who have received a full range of vaccinations in accordance with age (vaccination and two revaccinations).
4. - Group II - children aged 14 years who have received a set of vaccinations in accordance with their age.
5. Poliomyelitis survivors cannot be included in indicator groups; children who lack information about vaccinations; not vaccinated against polio; who have suffered any disease 1 - 1.5 months before the examination, since some diseases can lead to a temporary decrease in the titer of specific antibodies. Each indicator group must represent a homogeneous statistical population, which requires selection of individuals with the same number of vaccinations and period from the date of vaccination last vaccination
6. . In this case, this period must be at least 3 months. The number of each indicator group must be at least 100 people. Optimally, 4 teams of one group should be selected for the survey.(2 teams from two medical institutions), at least 25 people in each team. In the case of a smaller number of indicator group children in children's groups, achieving representativeness of the research is achieved by increasing the number of preschool institutions where these studies will be conducted.
7. In children's groups, before a serological examination, medical workers should carry out explanatory work with parents about the need to prevent polio and determine post-vaccination immunity to it.
8. The period during which sera are collected and delivered to the virology laboratory of the Federal State Institution "Center for Hygiene and Epidemiology in the Orenburg Region" should not exceed 7 days.

Rules for collecting, transporting and storing blood serum

1. 1. Technique for collecting and primary blood treatment
2. When conducting serological studies, only one blood sample is required from each person included in the observed group. The minimum amount of blood serum required for the study is at least 0.2 ml; it is better to use 1 ml. Therefore, the minimum blood sample volume should be at least 0.5 ml; optimally 2 ml. It is better to take blood from a vein, since this method is the least traumatic and allows you to obtain the required volumes with a minimum level of hemolysis.
3. Blood from a vein in an amount of 5 ml is taken with a disposable sterile syringe into a sterile tube under aseptic conditions.
4. If taking blood from a vein cannot be carried out for some reason, the blood is taken by pricking a finger. In this way, it is possible to obtain a sufficient amount of blood for serological studies. Blood in a volume of 1.0 - 1.5 ml is collected directly through the edge of a sterile disposable centrifuge tube with a stopper (or into special microtubes for collecting capillary blood). Before drawing blood, the patient's hand is warmed with hot water, then wiped dry with a clean towel. The finger is treated with a sterile cotton ball moistened with 70% alcohol and pierced with a sterile disposable scarifier. The puncture is made slightly away from the midline, closer to the lateral surface of the finger (the place where large vessels pass). Drops of blood protruding at the puncture site are collected with the edge of a dry, sterile measuring centrifuge tube so that the drops flow down the wall to the bottom. To obtain a large amount of blood, it is recommended to lightly massage the sides of the phalanx. In very young children, a blood sample can be obtained by pricking the heel.
5. After taking blood, the injection site is lubricated with a sterile cotton ball moistened with a 5% iodine solution.
6. The tube with blood is closed with a sterile rubber stopper, a strip of adhesive tape is glued to the tube, on which the number of the person being examined is written, corresponding to the serial number in the accompanying document, the surname and initials, and the date of collection. Before being sent to the laboratory, blood can be stored at a temperature of +4 - +8 degrees. With no more than 24 hours.
7. In the laboratory, to obtain serum, a test tube with blood is left in an inclined (at an angle of 10 - 20 degrees) position at room temperature for 30 minutes. to form a clot; after which the test tube with blood is shaken to separate the clot from the wall of the tube and left overnight in the refrigerator at a temperature of +4 - 8 degrees. WITH.
8. After removing the serum from the clot (the tubes are circled along the inner surface with a Pasteur pipette), it is centrifuged at 1000 - 1200 rpm. for 15 - 20 minutes. Then the serum is carefully poured or aspirated with a pipette with a bulb into sterile centrifuge (plastic) tubes or Eppendorf tubes with the obligatory transfer of the label from the corresponding tube to them.
9. If the laboratory does not have a centrifuge, then whole blood should be left in the refrigerator until complete clot retraction (separation of the red blood cell clot from the serum) occurs. Carefully, carefully, avoiding damage to red blood cells, transfer the serum to another sterile tube equipped with a label. The serum should be transparent, light yellow in color, without significant hemolysis.
10. Serum arriving at the laboratory (without a clot) can be stored until examination in household refrigerators at a temperature of 4 degrees. C within 7 days. For longer storage, the whey can be frozen at -20 degrees. WITH.
11. 2. Transportation of serum (blood) samples
12. Before transportation collected material It is very important to take precautions: check the availability of the collected information, tightly cap the tubes, arrange the samples according to their numbers, place the sera in a plastic bag.
13. To transport blood (serum), thermal containers (cooler bags, thermos) should be used. If refrigeration elements are used (they must be frozen), you need to place them on the bottom and sides of the container, and then place a plastic bag with serum samples inside, and put the frozen elements back on top. Place the accompanying documents, indicating the date and time of departure, in a plastic bag and place it under the lid of the thermal container.
14. When carrying out seromonitoring, blood (serum) samples are accompanied by a carefully completed accompanying document - “List of persons subject to serological examination for the presence of specific antibodies to poliovirus” (attached).
15. When preparations for shipment are completed, inform the recipient about the time and method of transportation, the number of samples, etc.
16. Samples are delivered to the virology laboratory of the Federal State Institution "Center for Hygiene and Epidemiology in the Orenburg Region" (Orenburg, 60 Let Oktyabrya St., 2/1, tel. 33-22-07).
17. At the place of collection of blood serum samples, duplicate lists of examined persons and the results of serum testing should be stored for at least 1 year.
18. The results are also entered into accounting forms (history of the child’s development, outpatient card of the patient).
19. List of persons
20. subject to serological examination for the presence
21. specific antibodies to poliovirus (seromonitoring)
22. (pre) In _____________ in _______ year city, district Name of health care facility __________________________ Name of institution ___________________ N Preschool (group), school (class), etc. (/pre)

The factors influencing the intensity of the immune response in people to the introduction of vaccines are indicated. Data are presented on significant fluctuations in the level of antibodies in those vaccinated with the same vaccine: from very high titers of antibodies to their complete absence. The need to correct the development of immunity during vaccination is substantiated, and methods and means of such correction are described. It is proposed to use the principles of individualization of vaccination, primarily in groups increased risk.

Most effective method The fight against infectious diseases is vaccination of the population. Each country develops its own vaccination calendar, taking into account the specifics of the epidemic situation, the availability of registered vaccines, financial capabilities and other factors. All countries and large regions use a differential approach to vaccination of certain groups of people and individual contingents, taking into account:

• demographic factors;
• natural and climatic conditions;
• epidemiological situation;
• social factors.

There are high-risk groups of people whose vaccination has its own characteristics:

• risk groups associated with professional characteristics(medical workers, catering staff, etc.);
• elderly and elderly persons;
• pregnant women;
• newborns;
• traveling abroad to endemic regions;
• refugees.

Groups of children at particularly high risk include:

• premature and weakened children;
• children with immunodeficiencies (congenital immunodeficiencies, HIV infection, radiation, drug immunosuppression, etc.);
• patients with acute and chronic diseases (frequent ARVI, diseases of cardio-vascular system, diseases of the blood, endocrine and nervous systems, etc.).

For differential vaccination the following are used:

• vaccines of the same name with to varying degrees reactogenicity and immunogenicity (live, inactivated, split, subunit vaccines);
• vaccines with a reduced content of toxoid (ADS-M, AD-M vaccines for routine age-related immunization) or with a reduced number of bacterial cells (BCG-M vaccine for vaccination of premature and weakened children);
• routine and accelerated immunization schedules against certain infections, such as hepatitis B;
• different doses of vaccines for adults and children when immunized with the same vaccine (vaccines against hepatitis A and B, influenza, tick-borne encephalitis, etc.).

Unfortunately, this is where selective vaccination methods end. Vaccination of people is limited to the requirements of the vaccination calendar, various provisions and instructions, deviation from which entails legal liability in the event of post-vaccination complications. The vaccination calendar with average doses of vaccines and strict vaccination limits equalizes the conditions for immunization of the majority of citizens and is designed for an average person in terms of immunological activity.

In practice, individual vaccination regimens are not used, not to mention the use of any individual vaccines. In the recent past, attempts have been made to use autologous vaccines to treat chronic infectious diseases (4, 21). Such vaccines were prepared from microbial flora isolated from a specific patient and used to treat the same patient. Despite the good therapeutic effect, such vaccines are not produced due to great technological difficulties and the unprofitability of independent quality control.

When discussing issues of immunological individualization of vaccination and developing principles for its implementation, it is important to agree on the very concept of immunological individualization of vaccination. The following definition can be given: immunological individualization of vaccination is the correction of the immune response to vaccines using different means and vaccination methods to ensure that each person vaccinated has sufficient immunity (14). For such correction, different doses and vaccination schedules can be used, as well as additional means of immunomodulation of the immune response.

People's sensitivity to infectious diseases is associated with the presence on their cells of special receptors for the pathogens that cause these infections. Mice are not susceptible to infection by the polio virus. However, transgenic TgPVR mice, sensitive to polio, were created by introducing into their genome a gene encoding a cellular receptor for the polio virus (34, 38). The solution to the problems of individual vaccination would be greatly accelerated if we knew the degree of sensitivity of each person to individual infections. There are no reliable methods for determining such sensitivity yet.

Immunological anti-infective resistance is under polygenic control; it consists of two systems of resistance: nonspecific and specific. The first system includes nonspecific immune factors and is controlled primarily by genes not associated with the major histocompatibility complex (MHC). The second system ensures the development of acquired immunity associated with the formation of antibodies and effectors of cellular immunity. This system has its own genetic control, depending on the MHC genes and their products (12, 13, 15).

There is a close connection between a person’s sensitivity to certain types of infections, the intensity of the emerging immunity and the presence or absence of certain histocompatibility antigens, which are controlled by genes located in the A, B and C loci of class I and the DR, DQ and DP loci of class II of the HLA system ( table 1).

Table 1. Immunity, infections and HLA system

Infections	Association of HLA gene products with immunity and infections		Literature
	Immunity	Infections
Leprosy	A1O, A1, B8, B14, B17, B7, BW40, B40, DR2, DR1, DR8	A2, AW19, DR4, DRW6	1, 37, 44,45
Tuberculosis	BW40, BW21, BW22, BW44, B12, DRW6	B5, B14, B27, B8, B15, A28, BW35, BW49, B27, B12, CW5, DR2	1, 25, 26, 32, 41
Salmonella		A2	1
Infections caused by S. aureus	DR1, DR2, BW35	DR3	1
Malaria	BW35, A2-BW17	B53,DRB1	1,27
Measles		A10, A28, B15, B21	2
HIV infection	B27	B35, A1-B8-DR3	29, 30, 31, 33, 35, 40
Hepatitis B	DRB1		28, 42
Hepatitis C	DR5		39, 43, 46

Insufficiently strong immunity to measles is associated with the presence of histocompatibility antigens AJ, A28, B15, B21, and the relative risk levels of the disease according to these markers are 3.2; 2.3; 3.4 and 4.0 (2). The presence of certain histocompatibility markers negatively affects the course of this infection. In persons whose genotype contains antigens A2, B7, B13, Bw 35, DR 2 and especially their combinations, measles is more severe compared to people with antigens Al, B8, Cwl, DR3 and their combinations (24).

The mechanisms of action of MHC gene products, the presence of which increases the risk of disease, remain unknown. According to the most common hypothesis of mimicry, the structure of some microbial antigens is similar to the structure of such products, which allows viruses and bacteria to avoid the protective reaction of the immune system.

The existence of an inverse association, when a high level of individual MHC antigens is combined with a high degree of resistance to the infectious agent, is explained by the fact that these antigens are products of lr genes (immune response genes), on which the strength of the immune response to specific antigens depends. It is known that different people respond differently to the same vaccine. There are groups of people with strong and weak immune responses to each vaccine. The majority of people occupy the middle position (3, 5, 6, 13, 17).

The strength of the immune response to a specific antigen depends on many factors: the composition of the vaccine and its antigens, the genotype of the organism, its phenotype, age, demographic, professional factors, factors environment, seasonal rhythms, state physiological systems and even from blood groups. People with blood group IV are more likely to experience T-system deficiency, which increases the risk of infections (8). In persons with I and III groups blood, lower titers of anti-diphtheria and anti-tetanus antibodies are observed (20).

Any antigen (bacteria, virus, large molecular antigen) after phagocytosis (pinocytosis) undergoes intracellular cleavage by phagolysosome enzymes. The resulting peptides interact with the MHC gene products formed in the cell and in this form are presented to lymphocytes. The lack of MHC products capable of binding to exoantigens leads to a decrease in the level of the immune response. Genetic control of the immune response and its restriction by MHC antigens is carried out on different levels immune system: at the level of auxiliary cells, helpers, effector cells, memory cells.

For many infections, a protective antibody titer has been determined that provides resistance to infection in vaccinated individuals (Table 2). Protective titer is, of course, a relative concept. Titers below the protective level can play a significant role in anti-infective resistance, and high antibody titers are not an absolute guarantee of protection.

Table 2. Protective and maximum antibody titers in vaccinated people

Infections	Antibody titers after vaccination		Antibody detection methods
	Protective titer	Maximum titles
Diphtheria	1:40	≥1:640	RPGA
Tetanus	1:20	≥1:320	RPGA
Whooping cough	1:160	≥1:2560	RA
Measles	1:10	≥1:80	RNGA
	1:4	≥1:64	RTGA
Mumps	1:10	≥1:80	RTGA
Hepatitis B	0.01 IU/ml	≥10 IU/ml	ELISA
Tick-borne encephalitis	1:20	≥1:60	RTGA

For some types of vaccines, a protective titer cannot be established. The level of circulating antibodies may not reflect the degree of protection of the body against infections, since in addition humoral immunity participates in any anti-infective resistance cellular immunity. For most infections, protection against which is due to cellular factors (tuberculosis, tularemia, brucellosis, etc.), protective titers of cellular reactions after vaccination have not been established.

All events on specific prevention vaccine-preventable diseases are aimed at creating herd immunity. To assess the effectiveness of such measures and the state of collective immunity, serological monitoring is carried out. The results of such monitoring indicate that even in the presence of collective immunity, there are always groups of people who do not have a protective level of antibodies (Table 3).

Table 3. Estimation of herd immunity to vaccine-preventable diseases *

Infections	Test systems	Contingent	Presence of antibodies	Number of vaccinated people with antibody levels below protective
Diphtheria, tetanus	RPGA	Children	Antibody titers less than 1:20	No more than 10%
	RPGA	Adults	Seronegative	No more than 20%
Measles	ELISA	Children	Seronegative	No more than 7%
Rubella	ELISA	Children	Seronegative	No more than 4%
Mumps	ELISA		Seronegative	No more than 15%
	ELISA	Children vaccinated once	Seronegative	No more than 10%
Polio	RN	Children	Seronegative	No more than 20% for each strain

* “Organization and conduct of serological monitoring of the state of collective immunity against vaccine-preventable infections (diphtheria, tetanus, measles, rubella, parotitis, polio). MU 3.1.1760 - 03."

The immune response to vaccination is different for each person. Individuals who respond poorly to one vaccine may respond well to another vaccine. Of primary importance in this phenomenon are the genetic characteristics of the organism, which are well studied in experiments on inbred mice using synthetic peptides containing 8-12 amino acids as antigens. Any large-molecular antigen used to prepare a vaccine contains several such determinant groups, each of them causing its own immune response. The immunological response to a vaccine is essentially the sum of the responses to the peptides, so differences between strong and weak vaccine responders are attenuated. An even more complex mosaic of immune responses occurs when complex vaccines are administered to prevent multiple infections. In this case, the majority of vaccinated people react well simultaneously to several complex antigens combination vaccines, however, it is always possible to identify groups of people who respond poorly to 1-2 or several types of vaccines (5).

Characteristics of the immune response to vaccines.

Weak answer:

• characterized by a low concentration of antibodies,
• does not provide specific protection against infections,
• is the cause of the development of bacteria and virus carriage.

A very strong answer:

• provides specific protection against infections,
• suppresses the formation of new antibodies,
• prevents the engraftment of the live vaccine virus,
• promotes the formation of immune complexes,
• increases the side effects of vaccines,
• increases economic costs.

The basis for developing the problem of correcting the development of immunity during vaccination is: the heterogeneity of the immune response to vaccines, the need for additional protection of individuals who respond poorly to vaccines, and the inappropriateness of excessive immunization.

The absence of an immune response and a weak immune response during vaccination is observed in 5-15% of practically healthy individuals. Children who respond poorly to vaccines are more common among children with clinical signs immunological disorders (16). More than 10% of people react poorly to certain types of vaccines: 11.7% - to live measles vaccine(2), 13.5% - on recombinant vaccine against hepatitis B (36), etc. In addition, a large percentage is practically healthy people respond poorly to weakly immunogenic vaccines.

The second side of the problem is excessive immunization. Due to the constant circulation of pathogens of some infections, natural immunization of people occurs without vaccination. Some of them have a high initial antibody titer and do not even need primary vaccination. Other individuals produce very high antibody titers after primary vaccination and do not need revaccination.

Among the vaccinated, one can always identify a group of people with high and very high level antibodies. This group makes up 10-15% of vaccinated people. When vaccinated against hepatitis B, antibody titers above 10 IU/ml are observed in 18.9% of people, with a protective titer of 0.01 IU/ml (36).

Overimmunization occurs more often with revaccination, which is required according to the instructions for use for most commercial vaccines. If antibody formation is intense, revaccination is unnecessary and undesirable. Individuals with high levels of preexisting antibodies respond poorly to revaccination (7,9). For example, among individuals who had high titers of anti-diphtheria antibodies before vaccination, in 12.9% of people there was no change in the concentration of these antibodies after administration of ADS-M toxoid, and in 5.6% of individuals, antibody titers became lower baseline(9). Thus, 18.5% of people did not need revaccination against diphtheria, and for some of them revaccination was contraindicated. From the point of view of expediency, medical ethics and cost-effectiveness, excessive immunization is unjustified.

Ideally, it is advisable to have an idea of ​​the strength of a person’s immunity to a specific infection even before vaccination. There are methods for mathematical prediction of the immunological effectiveness of vaccination (re-vaccination), based on immunological monitoring of large groups of people. However, the problem of predicting the development of immunity to a vaccine in individual people has practically not been developed. The difficulties of such forecasting lie in the fact that the immune response to a vaccine is always specific, and the body reacts differently to different vaccines.

There are several ways to determine indicators by which one could indirectly judge the immunological potential of the organism (18, 19). These indicators can be specific, associated with a specific antigen (vaccine), or nonspecific, characterizing the state of nonspecific immune factors. One should also take into account vaccination history, gender, age, profession, the presence of pathology in the vaccinated person and other nonspecific factors, which, naturally, are not absolute criteria for assessing the specific protection of people from specific infections (3). Data from immunological studies must be entered into medical records all those vaccinated. These data will be the basis for deciding on the need to use immune correction agents.

Immunity assessment can be performed before and after primary immunization or at any stage of the vaccination cycle. This allows you to determine the need for further immunization, cancellation of vaccination, or, conversely, taking measures to strengthen the immune response in the vaccinated person. Correction of the level of immunity based on antibody titers in high-risk individuals is accessible and feasible. Standard highly sensitive test systems that have passed all stages of registration should be used. It is advisable to develop test systems for simultaneous determination of the level of antibodies to antigens of many vaccines, for example, vaccines of the vaccination schedule.

To assess immunity, two parameters can be taken: the protective titer and the upper level of antibodies, which is not advisable to exceed through repeated vaccination. Establishing the upper antibody level is much more difficult than establishing the protective titer. As such a level, the upper titer values ​​can be used, slightly lower than the maximum values ​​determined in clinical trials each vaccine.

In the practice of vaccine prevention, it is impossible to arbitrarily change vaccination schedules, however, even now, the instructions for the use of vaccines for the prevention of certain infections (rabies, tularemia, Q fever, etc.) require additional doses of drugs to be administered to recipients, provided that the level of antibodies after the previous vaccination did not reach protective titer.

Advantages of individualization of vaccination:

• in more short term collective immunity is formed,
• the circulation of infectious agents is reduced,
• the number of cases of bacterial and viral carriage decreases,
• a large contingent of the population will be protected, another contingent will be spared from hyperimmunization,
• frequency decreases adverse reactions during vaccination,
• Many ethical problems of vaccination will be resolved.

Immunological personalization of vaccination can be carried out through the selection of a vaccine among vaccines of the same name, the choice of doses, vaccine administration regimens, the use of adjuvants and other means of immunomodulation. Naturally, each vaccine has its own characteristics and each vaccine preparation requires its own immunological correction tactics. However, we can recommend general methods and means for correcting the immune response to different kinds vaccines.

In healthy individuals with a level of immunity below protective:

• increasing the dose of the vaccine,
• use of more immunogenic unidirectional vaccines,
• the use of additional means of increasing the immunogenicity of vaccines (adjuvants, cytokines, etc.),
• changing the vaccination schedule (additional vaccination, etc.).

In healthy individuals with overproduction of antibodies:

• reducing the dose of vaccines,
• reduction of the primary vaccination schedule,
• refusal of revaccination. In persons with pathology:
• use of vaccines with reduced antigen load,
• the use of vaccines administered using gentle methods,
• changing the vaccination schedule.

Research suggests that protective antibody titers can be achieved with additional stimulation in most individuals with a weak immune response. The number of refractory people who do not respond to a specific vaccine, which is associated with the genetic characteristics of these individuals, does not exceed tenths of a percent.

In medical practice, there are not yet conditions for determining the level of antibodies in all vaccinated people, although serological monitoring is widely used to assess collective immunity, and serological screening is used to select groups of people when testing new vaccines, for example, vaccines against diphtheria (11), hepatitis B (36 ) and other infections.

The principles of immunological correction of vaccination should be extended primarily to risk groups, for example, when vaccinating people with different types pathologies: immunodeficiencies (23), allergies (10), malignant neoplasms (22), HIV infection, radiation, drug immunosuppression, etc.

Not all provisions expressed in the article are indisputable; some of them require additional research. It is important that the problems of immunological individualization of vaccination be discussed in the scientific community and be developed as quickly as possible. Naturally, all changes in doses and schedules of administration of specific vaccines, as well as the use of means and methods for individualizing vaccination, must be reviewed and approved in the prescribed manner.

One can, of course, argue that the immunological correction of vaccination is not so necessary, since proper vaccination can already prevent epidemic process for any vaccine-preventable disease. At the same time, it should be taken into account that thanks to the introduction of immunological correction methods, most of the low-responsive individuals will be protected from infections, and the other part of the population will be spared from unnecessary hyperimmunization. Both of these groups of people make up about 20-30% of all those vaccinated. There is every reason to believe that individual correction Vaccinations will significantly reduce the incidence of adverse reactions and complications after vaccination. Selective immunization can solve many of the pressing ethical issues surrounding mass vaccination.

The costs of introducing immunological correction methods will largely be offset by the abolition of vaccination for 10-15% of hyperreactive people, and, as a result, large savings in vaccines. There will be a partial redistribution of the volume of vaccines from those for whom they are not indicated to those who need them to additionally stimulate the immune system.

In conclusion, it should be noted that the problem of immunological individualization concerns not only vaccines, but also other immunobiological preparations, primarily various immunomodulators, which are widely used for the prevention and treatment of many types of pathologies in humans.

Pathogenesis of polio
poliovirus
mucous membrane: nasopharynx (entrance gate)
epithelial cells of the mucous membrane intestines The lymph nodes pharyngeal ring small intestine (Peyer's patches) (primary reproduction)		Isolation of poliovirus: from the pharynx (from the incubation period until the appearance of the first symptoms) - infection of people by airborne droplets in epidemic foci with feces (1 g contains 1 million infectious doses) - the main route of transmission of infection
(viremia stage lasts from several hours to several days)
formation of immune complexes
increasing the permeability of the blood-brain barrier
penetration of poliovirus (through the axons of peripheral nerves) into neurons: spinal cord brain		If virus-neutralizing antibodies accumulate in the blood, blocking the penetration of poliovirus into the central nervous system, no central nervous system damage is observed.
poliovirus reproduction (secondary target organs): motor neurons of the anterior horn of the spinal cord cerebral neurons neurons medulla oblongata
deep (often irreversible) degenerative changes in the cytoplasm - crystal-like accumulations of virions
flaccid atrophic paresis and paralysis

There are four clinical forms polio:

paralytic (1% of cases), it is most often caused by polyvirus serotype I

meningeal (1% of cases - aseptic meningitis, without the development of paralysis)

abortifacient or “minor disease” ( light form proceeding without damage to the central nervous system)

inapparent (hidden).

Poliomyelitis often occurs in two stages: after a mild form and significant improvement, a severe form of the disease develops.

Immunity in polio

Active post-infectious - humoral (virus-neutralizing antibodies have protective properties - therefore post-infectious immunity is type-specific - which appear even before the onset of paralysis, reach maximum titers after 1 - 2 months and persist for many years, providing almost lifelong immunity).

Passive (maternal) persists for 4–5 weeks of the child’s life.

It should be noted that a high concentration of antibodies in the serum does not prevent the development of paralysis after poliovirus has penetrated the central nervous system.

Diagnosis of polio

Isolation of the virus from the patient’s body (from nasopharyngeal swabs, blood, feces - depending on the period of the disease, posthumously - pieces of brain tissue and lymph nodes)

cultivation method - in cell cultures

indication - CPD

identification - RN

It should be noted that virus isolation, especially from feces, is not an absolute basis for diagnosis, given the widespread prevalence of asymptomatic carriage.

In conditions of mass vaccination with a live vaccine, intratype differentiation of “wild” (virulent) and vaccine variants of poliovirus is necessary:

Serological diagnosis in paired sera (the first days of the disease and 2-3 weeks after the onset of the disease, an increase in titer of at least 4 times has diagnostic significance), antibodies are also detected in the cerebrospinal fluid:

For both methods, you can also use RPG and color proof.

Immunoprophylaxis of polio

Inactivated vaccine. Obtained by J. Salk (1953, USA) by treating the virus with a formaldehyde solution. Provides intense type-specific humoral immunity.

Advantages:

deprived of the possibility of mutations that can lead to an increase in virulence

less reactogenic (can be used for prevention of people with immunodeficiency and weakened children)

Flaws:

the need for three times parenteral administration

does not provide reliable local intestinal immunity, and therefore does not prevent the circulation of polioviruses among the population.

Attenuated vaccine. Obtained by A. Sabin (1956, USA).

Vaccine strains are genetically stable, do not revert to the “wild type” during passage through the human intestines and do not reproduce in CNS cells.

In 1958, A.A. Smorodintsev and M.P. Chumakov developed an oral vaccine based on Sabin strains (currently available in liquid form). This vaccine is one of the mandatory vaccinations.

Advantages:

provides not only general humoral, but also local intestinal immunity (due to the synthesis of IgAS)

as a result of the interference of vaccine viruses with “wild” types in the epithelial cells of the mucous membrane of the small intestine, the latter are eliminated from the intestine

Flaws:

administered orally, which greatly facilitates its use

the need for constant monitoring of the genetic stability of the vaccine strain

less reliable in tropical countries

cannot be used for vaccination of immunodeficient persons and weakened children (risk of developing paralysis)

Passive immunoprophylaxis

Human immunoglobulin is used (to prevent the development of paralytic forms), although its use is very limited..

The role of Coxsackie and ECHO viruses in human pathology

These viruses cause polio-like diseases, damage to internal organs, acute respiratory infections, acute respiratory infections, and damage to the central nervous system in humans..

Aftovirus and human pathogenicity of foot and mouth disease virus

The foot-and-mouth disease virus, which causes a highly contagious disease in cloven-hoofed domestic animals, is classified as a separate genus of the picornavirus family.

The source of infection is sick animals.

A person becomes infected:

contact (when caring for sick animals) is the main route of infection

Clinically, foot and mouth disease in humans manifests itself as vesicular rashes on the mucous membranes of the mouth, larynx and skin. Damage to internal organs is rare.

Rhinoviruses, epidemiology, pathogenesis, immunity and diagnosis of acute contagious rhinitis.

Rhinoviruses

Rhinovirus virions are spherical in shape, with a diameter of 20 - 30 nm.

Unlike enteroviruses, they lose their infectious properties in an acidic environment.

Cultivated in cell cultures, causing CPE in them.

115 serotypes of rhinoviruses have been identified, many of which have identical antigens responsible for cross-reactions.

Epidemiology

The spread of rhinoviruses occurs through airborne droplets.

Rhinoviruses are the main causative agents of colds in humans.

Pathogenesis

Immunity

After the disease, a short-term (2 years) type-specific immunity remains, which is determined mainly by IgAS.

Diagnostics

General characteristics and composition environmental group arboviruses. Togaviruses: classification, structure, role in human pathology.

The concept of filoviruses..

General characteristics and ecological groups of arboviruses

Arthropod borne – transmitted by arthropods.

Arthropods are both vectors and hosts.

Syndromes:

Fevers of undifferentiated type

Hemorrhagic fevers

Encephalitis

2 and 3 – high mortality Definition

– viruses that cause natural focal diseases, usually transmitted by arthropods and causing 1 - 3.

See also p. 281-283..

Composition of the ecological group of arboviruses

Mostly viruses of the families:

See also p. 281-281..

Togaviruses: classification, structure, role in human pathology

Togaviruses that are pathogenic for humans belong to the genera Alfavirus (they belong to the arbovirs) and Rubivirus (the causative agent of rubella, but not to the arboviruses).

Complex viruses with a diameter of 45-75 nm, having a cubic type of symmetry and single-stranded RNA. Alphaviruses infect the central nervous system skin

(hemorrhagic rash - hemorrhagic fevers), muscles and internal organs..

The concept of filoviruses

They have a thread-like appearance, hence the name (filum - thread). They include two viruses: the Marburg virus and the Ebola virus, which cause the same severe (with a mortality rate of up to 50%) hemorrhagic fevers, characterized by massive bleeding from the surface of all mucous membranes and necrotic lesions of internal organs. Flaviviruses: general characteristics

families;Flaviviridae

Complex, single-stranded RNA containing viruses with a diameter of 40-50 nm. A typical virus is the yellow fever virus (hence the name: flavus - yellow).

Contains more than 50 viruses, grouped into four antigenic groups:

tick-borne encephalitis group

Japanese encephalitis group

dengue fever group

yellow fever group

Epidemiology, pathogenesis, immunity, diagnosis and immunoprophylaxis of tick-borne encephalitis.

Epidemiology

The disease is widespread over a vast area from Far East to Central Europe (tick-borne encephalitis virus is a typical arbovirus of the temperate zone) and is recorded mainly in the spring-summer period.

Two antigenic variants of tick-borne encephalitis virus have been identified:

transmitted by Ixodes persulcatus ticks, which causes severe form infections in the Far East;

transmitted by Ixodes ricinus ticks, which causes a milder form of infection.

The virus persists in the body of ticks at all stages of their development and is transmitted transovarially to offspring. Therefore, ticks are considered not only as carriers, but also as the main reservoir of the tick-borne encephalitis virus (an additional reservoir is the hosts of ticks - rodents, birds, wild and domestic animals).

Ticks transmit the virus (transmissively) to farm animals, which develop an asymptomatic infection with viremia (in cows and goats, the virus passes into the milk).

Pathogenesis

The virus is transmitted to humans through the bite of an infected tick, as well as through the nutritional route - through raw cow's and goat's milk. Incubation period varies from 1 day to a month.

At the first stage, the virus enters the blood and is primarily reproduced in lymphocytes, hepatocytes, cells of the spleen and vascular endothelium (extraneural reproduction), after which it spreads through hematogenous and lymphogenous routes, penetrating the brain, where it affects the motor neurons of the anterior horns of the cervical segment of the spinal cord, the cerebellum and pia mater of the brain.

Immunity

After an illness, intense humoral immunity is formed. A week after infection, antihemagglutinins appear, by the end of the second week, complement-fixing antibodies, and a month later, virus-neutralizing antibodies.

Diagnostics

The virus is isolated from the blood and cerebrospinal fluid of patients. The most universal method is intracerebral infection of 1-3-day-old suckling mice; after signs of the disease appear, their brains are passaged with 3-4 successive infections, after which the virus reaches the brain tissue high titer and it can be used for antigen preparation and identified in RSC and RTGA with a set of immune sera. The final identification is carried out in the pH (the most specific reaction).

It should be remembered that working with pathological material poses a great danger in terms of inhalation infection and should be carried out in specialized laboratories.

Express diagnostics is based on the detection of viral antigen in the blood using RNGA, ELISA or parts of the virus genome using PCR.

Antibodies are detected in paired sera (see above for the dynamics of their appearance).

Immunoprophylaxis

For specific prevention, a vaccine inactivated by formaldehyde is used (persons working in natural areas are subject to mandatory vaccination).

As a passive immunoprophylaxis against a tick bite, a specific immunoglobulin (donor or heterologous) is administered.